BACKGROUND The existence of an association between cardiovascular diseases (CVDs) and apical periodontitis (AP) remains unclear because results obtained from previous clinical studies and reviews are inconsistent or inconclusive. OBJECTIVE To conduct an umbrella review to determine whether there is an association between CVDs and the prevalence of AP in adults. METHODS The protocol of the review was registered in the PROSPERO database (CRD42020185753). The literature search was conducted using the following electronic databases: Clarivate Analytics' Web of Science Scopus, PubMed and Cochrane Database of Systematic Reviews, from inception to May, 2020, with no language restrictions. Systematic reviews with or without meta-analysis that evaluated the association between CVDs and AP were included. Other types of studies, including narrative reviews, were excluded. Two reviewers independently performed a literature search, data extraction and quality assessment of included studies. Any disagreements or doubts were resolved by a third reviewer. The quality of the reviews was assessed using the AMSTAR 2 tool (A measurement tool to assess systematic reviews), with 16 items. A final categorization of the systematic reviews classified each as of 'high', 'moderate', 'low' or 'critically low' quality. RESULTS Four systematic reviews were included in the current review. Three reviews were graded by AMSTAR 2 as 'moderate' quality, whereas one review was graded as 'critically low' quality. DISCUSSION Only one systematic review included a meta-analysis. Substantial heterogeneity amongst the primary studies included within each systematic review was notable in preventing a pooled analysis. CONCLUSIONS From the limited 'moderate' to 'critically low' quality evidence available, the current umbrella review concluded that a weak association exists between CVDs and AP. In the future, well-designed, longitudinal clinical studies with long-term follow-up are required.

中文翻译：

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心血管疾病与根尖周炎之间的关联：综合综述。

背景 心血管疾病 (CVDs) 和根尖周炎 (AP) 之间是否存在关联仍不清楚，因为从以前的临床研究和评论中获得的结果不一致或不确定。目的 进行一项综合性审查，以确定 CVD 与成人 AP 患病率之间是否存在关联。方法 审查方案在 PROSPERO 数据库 (CRD42020185753) 中注册。文献检索使用以下电子数据库进行：Clarivate Analytics 的 Web of Science Scopus、PubMed 和 Cochrane 系统评价数据库，从开始到 2020 年 5 月，没有语言限制。包括有或没有评估 CVD 与 AP 之间关联的荟萃分析的系统评价。其他类型的研究，包括叙述性评论，被排除在外。两名评价员独立进行了文献检索、数据提取和纳入研究的质量评估。任何分歧或疑问均由第三位评审员解决。使用 AMSTAR 2 工具（评估系统性评论的测量工具）评估评论的质量，共有 16 个项目。系统评价的最终分类将每一项分类为“高”、“中”、“低”或“极低”质量。结果 四项系统评价被纳入当前评价。三篇评论被 AMSTAR 2 评为“中等”质量，而一篇评论被评为“极低”质量。讨论 只有一项系统评价包括荟萃分析。每个系统评价中包含的主要研究之间的大量异质性在阻止汇总分析方面是显着的。结论 从有限的“中等”到“极低”质量证据可用，目前的综合性审查得出结论，CVD 和 AP 之间存在弱关联。未来，需要精心设计、长期随访的纵向临床研究。